Active NPI
Corey Joe Sheppard, DDS
- Dentist
- Charleston, SC
National Provider Identifier
1568554574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901019364
- Practice address
- 29 Bee St
4TH Floor
Charleston, SC 29425-0001 - Phone
- (843) 876-8815
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901019364 | MI | Primary |
Addresses
Primary practice location
29 Bee St
4TH Floor
Charleston, SC 29425-0001
Mailing address
469 Cessna Ave
Charleston, SC 29407-2253
Phone (757) 289-1218
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901019364 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336521600000",
"number": "1568554574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "469 CESSNA AVE",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294072253",
"telephone_number": "757-289-1218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 BEE ST",
"address_2": "4TH FLOOR",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294250001",
"telephone_number": "843-876-8815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPPARD",
"first_name": "COREY",
"middle_name": "JOE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2012-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901019364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.